Medicare and You Handbook 2006 - CT.gov

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Section 6: Medicare Prescription Drug Coverage
You Need To Make An Important Decision About Your
Prescription Drug Coverage.
The prescription drug coverage option you choose affects
■ Coverage
Medicare drug plans will cover generic and brand-name drugs. Plans may have
rules about what drugs are covered in different drug categories.This makes sure
people with different medical conditions can get the treatment they need.
Most plans will have a formulary, which is a list of drugs covered by the plan.
This list must always meet Medicare’s requirements, but it can change when
plans get new information. Your plan must let you know at least 60 days
before a drug you use is removed from the list or if the costs are changing.
If your doctor thinks you need a drug that isn’t on the list, or if one of your
drugs is being removed from the list, you or your doctor can apply for an
exception or appeal the decision.
■ Cost
Monthly premiums and your share of the cost of your prescriptions will vary
depending on which plan you choose. If you have limited income or resources,
you may qualify for extra help paying your drug plan costs (see Section 7).
■ Convenience
Drug plans must contract with pharmacies in your area. Check with the plan
to make sure the pharmacies in the plan are convenient to you. Some plans
also allow you to get your prescriptions through the mail.
■ Security Now and in the Future
Even if you don’t take a lot of prescription drugs now, you still should
consider joining a drug plan in 2006. As we age, most people need
prescription drugs to stay healthy. For most people, joining now means you
will pay your lowest possible monthly premium. If you don’t join a plan by
May 15, 2006, and you don’t currently have a drug plan that, on average,
covers at least as much as standard Medicare prescription drug coverage, you
will have to wait until November 15, 2006 to join. When you do join, your
premium cost will go up at least 1% per month for every month that you
wait to join. Like other insurance, you will have to pay this penalty as
long as you have Medicare prescription drug coverage. If you join by
December 31, 2006, your coverage will begin January 1, 2007.